Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients
Pichai Ittasakul,1 Apichaya Likitnukul,1 Umporn Pitidhrammabhorn,1 Punjaporn Waleeprakhon,1 Morris B Goldman2 1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine,...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2019-02-01
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| Series: | Neuropsychiatric Disease and Treatment |
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| Online Access: | https://www.dovepress.com/stimulus-intensity-determined-by-dose-titration-versus-age-based-metho-peer-reviewed-article-NDT |
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| author | Ittasakul P Likitnukul A Pitidhammabhorn U Waleeprakhon P Goldman MB |
| author_facet | Ittasakul P Likitnukul A Pitidhammabhorn U Waleeprakhon P Goldman MB |
| author_sort | Ittasakul P |
| collection | DOAJ |
| description | Pichai Ittasakul,1 Apichaya Likitnukul,1 Umporn Pitidhrammabhorn,1 Punjaporn Waleeprakhon,1 Morris B Goldman2 1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Objectives: This study aimed to compare the accuracy of the stimulus intensity (SI) calculated by age-based methods with that using the dose-titration method. Methods: The initial seizure threshold (IST) was determined using a standardized dose titration in hospitalized Thai patients treated with right unilateral (RUL, n=32) and bilateral (BL, n=57) electrode placement. The correlation between the IST and clinical variables was analyzed. The estimated SI based on the patient’s age was compared with the SI determined by dose titration. Results: Age was highly predictive of the IST for both groups (RUL, P=0.012; BL, P=0.045). Gender (P=0.006) and anticholinergic drug use (P=0.025) predicted the IST for the BL group. For the RUL group, the mean±SD (median) SI estimated using the half-age and age methods was 158±46 (169) mC and 315±92 (338) mC, respectively. The SI determined using the dose-titration method was higher compared with the half-age method and lower compared with the age method. For the RUL group, 31% of subjects using the half-age method and 22% of subjects using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 19% of subjects using the half-age method and 19% using the age method would have received unacceptably low (<50%) or high (>200%) intensities. For the BL group, 18% of subjects using the half-age method and 32% using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 39% with the half-age method and 18% with the age method would have received an unacceptably low or high SI, respectively. Conclusion: Age strongly predicts the IST, but it does not robustly predict the SI compared with dose titration because the SI calculated using age-based methods results in an unacceptably low or high SI that is associated with a marked risk of adverse effects or inadequate response. We recommend the dose-titration method to determine the SI. Keywords: electroconvulsive therapy, dosing, Thai patients, dose titration, age-based methods, seizure threshold, predictors |
| first_indexed | 2024-12-23T04:10:07Z |
| format | Article |
| id | doaj.art-acf97a93d82249a5b3354d8f323acc28 |
| institution | Directory Open Access Journal |
| issn | 1178-2021 |
| language | English |
| last_indexed | 2024-12-23T04:10:07Z |
| publishDate | 2019-02-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Neuropsychiatric Disease and Treatment |
| spelling | doaj.art-acf97a93d82249a5b3354d8f323acc282022-12-21T18:00:31ZengDove Medical PressNeuropsychiatric Disease and Treatment1178-20212019-02-01Volume 1542943443938Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patientsIttasakul PLikitnukul APitidhammabhorn UWaleeprakhon PGoldman MBPichai Ittasakul,1 Apichaya Likitnukul,1 Umporn Pitidhrammabhorn,1 Punjaporn Waleeprakhon,1 Morris B Goldman2 1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Objectives: This study aimed to compare the accuracy of the stimulus intensity (SI) calculated by age-based methods with that using the dose-titration method. Methods: The initial seizure threshold (IST) was determined using a standardized dose titration in hospitalized Thai patients treated with right unilateral (RUL, n=32) and bilateral (BL, n=57) electrode placement. The correlation between the IST and clinical variables was analyzed. The estimated SI based on the patient’s age was compared with the SI determined by dose titration. Results: Age was highly predictive of the IST for both groups (RUL, P=0.012; BL, P=0.045). Gender (P=0.006) and anticholinergic drug use (P=0.025) predicted the IST for the BL group. For the RUL group, the mean±SD (median) SI estimated using the half-age and age methods was 158±46 (169) mC and 315±92 (338) mC, respectively. The SI determined using the dose-titration method was higher compared with the half-age method and lower compared with the age method. For the RUL group, 31% of subjects using the half-age method and 22% of subjects using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 19% of subjects using the half-age method and 19% using the age method would have received unacceptably low (<50%) or high (>200%) intensities. For the BL group, 18% of subjects using the half-age method and 32% using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 39% with the half-age method and 18% with the age method would have received an unacceptably low or high SI, respectively. Conclusion: Age strongly predicts the IST, but it does not robustly predict the SI compared with dose titration because the SI calculated using age-based methods results in an unacceptably low or high SI that is associated with a marked risk of adverse effects or inadequate response. We recommend the dose-titration method to determine the SI. Keywords: electroconvulsive therapy, dosing, Thai patients, dose titration, age-based methods, seizure threshold, predictorshttps://www.dovepress.com/stimulus-intensity-determined-by-dose-titration-versus-age-based-metho-peer-reviewed-article-NDTECTdosingThai patientsdose titrationage-based methods |
| spellingShingle | Ittasakul P Likitnukul A Pitidhammabhorn U Waleeprakhon P Goldman MB Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients Neuropsychiatric Disease and Treatment ECT dosing Thai patients dose titration age-based methods |
| title | Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients |
| title_full | Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients |
| title_fullStr | Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients |
| title_full_unstemmed | Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients |
| title_short | Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients |
| title_sort | stimulus intensity determined by dose titration versus age based methods in electroconvulsive therapy in thai patients |
| topic | ECT dosing Thai patients dose titration age-based methods |
| url | https://www.dovepress.com/stimulus-intensity-determined-by-dose-titration-versus-age-based-metho-peer-reviewed-article-NDT |
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